Healthcare Provider Details

I. General information

NPI: 1184292971
Provider Name (Legal Business Name): AUNETTA B GARDNER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3921 PROSPERITY AVE
FAIRFAX VA
22031-3329
US

IV. Provider business mailing address

3921 PROSPERITY AVE
FAIRFAX VA
22031-3329
US

V. Phone/Fax

Practice location:
  • Phone: 804-475-8892
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701010573
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2608020
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701010573
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: